N. Thalji1, D. Kor2, M. Warner2, M. Zielinski1 2Mayo Clinic,Department Of Anesthesiology And Perioperative Medicine,Rochester, MN, USA 1Mayo Clinic,Department Of Surgery,Rochester, MN, USA
Introduction: Patterns of anticoagulant use in surgical patients are poorly characterized. Contrasting warfarin, direct oral anticoagulants (DOACs) offer rapid onset and obviate monitoring needs, but cannot be rapidly reversed. We aimed to define the prevalence, indications and temporal trends of anticoagulant use in surgical patients, with a focus on DOACs.
Methods: We studied adult non-cardiac surgical cases at our institution from 2007-2017. Cases on preoperative anticoagulation including DOACs (i.e. apixaban, dabigatran, edoxaban, rivaroxaban) were identified. Anticoagulated vs non-anticoagulated patients were compared using t-test/chi-square. We analyzed temporal trends in anticoagulation use by the Cochran Armitage trend test (significance p<0.05).
Results: A total of 361,360 cases were studied. Median (IQR) age was 59yrs (47–70) and 48% (172,355) were male. Overall, 8% (29,220) of cases received anticoagulation, representing 21,303 unique patients. Compared to 224,928 non-anticoagulated patients (332,140 cases), anticoagulated subjects were older (69 vs 59yrs), more frequently male (56% vs 47%), and had more comorbidities (Median [IQR] Charlson Index 5 [4–7] vs 3 [1–5]) (all p<0.001). Of anticoagulated subjects, AFib was present in 38%, DVT in 30%, PE in 10%, and prosthetic heart valves in 9%. From 2007-2017, the proportion of anticoagulated cases increased 32% (2007=6.7%, 2017=8.9%; p<0.001) (Fig1A). Of anticoagulated cases, 10% (2,865) were on DOACs, with most on apixaban (48%) or rivaroxaban (42%). In 2017, 31% of anticoagulated cases were on DOACs (Fig1B).
Conclusion: Operative cases for patients on home anticoagulation represent a significantly comorbid and increasing proportion of surgical volume. Widespread adoption of novel anticoagulants has culminated in DOAC use in 1/3 of contemporarily anticoagulated cases. Studies delineating perioperative risks for patients on DOAC therapy are increasingly relevant.
